title: Use of C2 spinous process screw for posterior cervical fixation as substitute for laminar screw in a patient with thin laminae.
abstract: Rigid screw fixation of C2 including transarticular screw and pedicle screw contain the risk of vertebral artery (VA) injury. On the other hand, translaminar screws are considered to be safer for patients with anomalous VA. But C2 translaminar screw placement was limited in patients who have thin laminas and there is marked variation in C2 laminar thickness. Appropriate C2 fixation method for a patient who has thin laminas and high-riding VA together was controversial. Here, we present a case of an elderly Asian woman who had thin laminas and high-riding VA together with progressive myelopathy to report a first case of C2 spinous process screw insertion. Although the stability and safety of C2 spinous process screw was reported in cadaver series, there was no clinical report to our knowledge. Spinous process screw can be an option of C2 fixation for patients with high-riding VA and severe degenerated cervical spines including thin C2 laminas.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan. koseinagata1984@gmail.com
authors.forename: Kosei
authors.initials: K
authors.lastname: Nagata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Baba
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Chikuda
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takeshita
mesh_terms: D000368:Aged; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome